Drug-eluting stents (DES) are associated with half the risk for restenosis and an equivalent risk for death and myocardial infarction (MI) compared with bare-metal stents (BMS) in patients with diabetes and coronary artery disease (CAD), a Swedish registry study suggests.

The results support the long-term safety and efficacy of DES in diabetic patients, who tend to have more extensive CAD and higher rates of disease progression and restenosis than their nondiabetic counterparts.

The national Swedish Coronary Angiography and Angioplasty Registry (SCAAR) records data on all patients undergoing coronary angiography and percutaneous coronary intervention. It also allows analysis of patient outcomes through linkage with other national databases.

For the present study, Stefan James (Uppsala Clinical Research Center) and fellow members of the SCAAR/SWEDEHEART study group evaluated long-term outcomes in patients with diabetes undergoing coronary angiography and stenting with either DES or BMS.

A total of 9710 diabetic patients underwent coronary stenting between 2003 and 2006, and were followed-up for a median of 2.5 years.

Analysis revealed that the composite outcome of death or MI was similar irrespective of the type of stent used, with a relative risk (RR) of 0.91 for DES versus BMS.

However, rates of both MI and restenosis were significantly lower in patients who received a DES, with RRs of 0.80 and 0.50, respectively, versus BMS. The reduction in restenosis was observed in patients with either stable or unstable CAD, and was most pronounced in those with a stent diameter of less than 3 mm or a stent length of more than 20 mm.

Importantly, the presence of restenosis was associated with a five-fold increased risk for MI (RR=50.3), irrespective of type of stent received.

“The use of DES in diabetic patients is considered off-label by the US Food and Drug Administration , because adequate numbers of diabetic patients have not been evaluated in clinical trials,” remark the authors.

“Despite this categorization, our real-life study shows that DES is safe and effective in reducing clinical restenosis in patients with diabetes mellitus.”

The study is reported in the European Heart Journal.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

Free abstract

Study results show that reconstituted high-density lipoprotein (rHDL) therapy reduces the hyper-reactivity of platelets of patients with Type 2 diabetes, partly by lowering the cholesterol content of platelet membranes.

“Individuals with diabetes mellitus have an increased risk of cardiovascular disease and exhibit platelet hyper-reactivity, increasing their resistance to antithrombotic therapies such as aspirin and clopidogrel,” explain researchers.

“As a consequence, more potent antiplatelet therapeutic strategies are increasingly being used to reduce thrombotic complications in diabetes mellitus; however, these approaches have minimal impact on atherosclerotic lesions themselves, leading to persistent plaque instability.”

Anna Calkin (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) and colleagues assigned 17 individuals with Type 2 diabetes to receive an infusion of placebo (n=10) or rHDL (n=7; CSL-111; 20 mg/kg/h) for 4 hours.

The rHDL group had a 1.4-fold increase in plasma HDL cholesterol levels from baseline to 4 hours. Platelets from these individuals following the infusions also had a more than 50% reduction in their aggregation response to multiple agonists compared with controls.

In an additional in vitro study of platelets from healthy volunteers, the inhibitory effects of rHDL on platelet function were shown to be time and dose dependent, and resulted in a widespread weakening of platelet function and a more than 50% reduction in formation of thrombi.

The researchers say that the isolated phospholipid component of rHDL, which enhances the release of cholesterol from platelets and reduces the lipid content of the cell membranes, is at least partly responsible for this effect.

Of note, the apolipoprotein A-I component of rHDL had little effect on platelet function or reduction of platelet cholesterol content.

“The greater platelet inhibitory properties of rHDL compared with native HDL suggest that agents that increase pre??”B-HDL particles would have the greatest efficacy with respect to reducing platelet reactivity,” comment Calkin et al.

They conclude in the journal Circulation: “Investigations to determine whether rHDL infusions or long-term HDL-raising agents confer additional benefits to current antithrombotic agents without adversely affecting hemostasis are required.

“The present findings add a new dimension to the known antiatherosclerotic actions of reconstituted HDL to provide a rationale for HDL-raising therapies as novel antithrombotic agents.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

Free abstract

Diabetics are especially at risk from hyperglycemia. Lest this topic be something that you cannot quite get your head around, I will discuss what “blood sugar” actually is before actually elaborating how to lower the levels of blood sugar. It is measured as the level of glucose - a kind of sugar - present in one’s bloodstream.

Although your body regulates your blood sugar by default, there is only so much it can do; watch your own actions, so as not to thwart your body’s sugar regulation. Your blood sugar is influenced greatly by the foods that you eat. There are those foods that lower the levels; while others - which enter the bloodstream more quickly - increase sugar. The higher sugar level in your blood, the harder your pancreas has to work to produce the required insulin.

You will find here listed tips for maintaining to your sugar, which will help to combat the threat of diabetes.

1. Eat the right foods - fruits, vegetables and grains are among the kinds of foods that get digested more slowly, this being good for maintaining the right sugar in your body.

2. Exercise is good for controlling your sugar level in blood. Also, losing weight reduces the likeliness of diabetes.

3. As far as lowering sugar in blood is concerned, four or five small meals a day is better than three large meals.

4. Do not drinking lots of soft drinks because these contain a lot of sugar and carbohydrates, and diabetics are very vulnerable to this.

5. Always read the labels that come with prescription drugs - would these increase your sugar notably?

6. Sometimes stress can be responsible for elevated sugar levels - consider making changes to your lifestyle.